Distributed fault tolerant architecture for a healthcare communication system

ABSTRACT

A healthcare communication system includes a first plurality of computer devices, such as patient stations, staff stations, and a master station, that are operable as a nurse call system. The first plurality of computer devices may have core nurse call functionality residing on an embedded computing platform. At least one of the first plurality of computer devices may have a graphical display screen. A second plurality of computer devices may be operable to provide the first plurality of computer devices with additional functionality via software plug-ins that are transmitted to the first plurality of computer devices. The first plurality of computer devices may be interconnected logically and/or physically in a tiered architecture arrangement to provide fault isolation among the tiers so that faults occurring in computer devices of one tier don&#39;t affect the operability of computer devices in other tiers and so that faults occurring in any of the second plurality of computer devices don&#39;t affect the core nurse call functionality of the first plurality of computer devices.

This application claims the benefit, under 35 U.S.C. § 119(e), of U.S.Provisional Patent Application Nos. 61/066,877, 61/066,882, 61/066,883,and 61/066,918, each of which was filed Feb. 22, 2008, and U.S.Provisional Patent Application No. 61/145,306, which was filed Jan. 16,2009, 2008, the disclosures of all of which are hereby expresslyincorporated by reference herein.

BACKGROUND

The present disclosure relates to healthcare communication systems, suchas nurse call systems. In particular the present disclosure relates tohealthcare communication systems having a master station and devices inpatient rooms that communicate with the master station.

Most hospitals and other types of in-patient healthcare facilities havesome sort of a nurse call system. Patients place nurse calls by pressinga nurse call button located on a hospital bed or on a hand-held unit,known in the art as a pillow speaker or pillow speaker unit, or byactuating a wall mounted switch. After a patient places a nurse call, acaregiver at a master station may answer the nurse call which enablesvoice communications between the caregiver at the master station and thepatient. To facilitate such voice communications a microphone andspeaker is located somewhere in the patient room. Oftentimes themicrophone and speaker are included in the pillow speaker unit or in anaudio station mounted to a wall of the patient or to headwall unit whichis, in turn, mounted to a wall of the patient room.

One example of a known nurse call system is Hill-Rom's COMLINX® system.In addition to the voice communication function, the COMLINX system isconnected to the patient's hospital bed to receive bed statusinformation regarding various aspects of the hospital bed such as theposition of the siderails of the bed (e.g., up or down), whether thebed's casters are braked or released, whether or not an upper frame ofthe bed is in its lowest position, and so forth. See, for example, U.S.Pat. Nos. 7,242,308; 6,897,780; 6,362,725; 6,147,592; 5,838,223;5,699,038; and 5,561,412, which relate to the COMLINX system. Anotherexample of a known nurse call system is G.E. Healthcare's TELLIGENCE™system.

SUMMARY

The present invention comprises a healthcare communication system and/ormethod, or a component thereof, that has any one or more of the featureslisted in the appended claims and/or any one or more of the followingfeatures, which alone or in any combination may comprise patentablesubject matter:

A healthcare communication system may comprise a first plurality ofcomputer devices that are operable as a nurse call system. The firstplurality of computer devices may have core nurse call functionalityresiding on an embedded computing platform. The first plurality ofcomputer devices may include patient stations, staff stations, or masterstations of the nurse call system and any of these stations may have agraphical display screen. The healthcare communication system may have asecond plurality of computer devices that are operable to provide thefirst plurality of computer devices with additional functionality viasoftware plug-ins that are transmitted to one or more of the firstplurality of computer devices. Some or all of the second plurality ofcomputer devices may be part of an Ethernet of the healthcare facility.

Use of a user interface displayed on the graphical display screen mayresult in at least one of the software plug-ins being transmitted to atleast one of the first plurality of computer devices. The firstplurality of computer devices may include an input/output (I/O) circuitthat is coupled to an associated patient station. Some of the softwareplug-ins may be operable to change the user interface of the graphicaldisplay screen to a different user interface. In response to a newcomputer device being added to the first plurality of computer devices,such as connecting a new patient station or staff station to the nursecall system, at least one of the second plurality of computer devicesautomatically transmits at least one software plug-in to the newcomputer device.

The additional functionality of the second plurality of computer devicesmay reside on a server computing platform. The second plurality ofsoftware devices may be configured such that at least one of thesoftware plug-ins is transmitted to the first plurality of computerdevices on an as needed basis as dictated by use of at least one of thefirst plurality of computer devices. Additionally or alternatively, thesecond plurality of software devices may be configured such that atleast one of the software plug-ins is transmitted to some or all of thefirst plurality of computer devices in response to use of at least oneof the second plurality of computer devices. Software upgrades orupdates installed on at least one of the second plurality of computerdevices may be distributed automatically to at least some of the firstplurality of computer devices. The software upgrades or updates may alsobe distributed automatically to at least one other computer device ofthe second plurality of computer devices.

The core nurse call functionality may comprise functionality regulatedby a regulations entity, such as a governmental body or standardssetting organization such as Underwriter's Laboratories, and theadditional functionality may comprise non-regulated functionality. Forexample, in some embodiments, the first plurality of computer devicesmay be compliant with the Underwriter's Laboratories UL-1069 standard.

The first plurality of computer devices and/or the second plurality ofcomputer devices may incorporate Publish and Subscribe (PubSub) datacommunication technology. The PubSub data communication technologypermits at least one computer device of the first plurality of computerdevices to publish data to, and/or to subscribe to data from, at leastone computer device of the second plurality of computer devices, andvice versa. At least one of the first plurality of computer devices maybe communicatively coupled to a hospital bed and may receive bed statusdata from the hospital bed.

At least one computer device of the first plurality of computer devicesmay have auto-discovery software that is operable, in response toinstallation of the at least on computer in the nurse call system, todetect network connectivity and to initiate communications with a devicemanager. The device manager may be operable to provide software modulesand/or network settings to the at least one computer device of the firstplurality of computer devices

The healthcare communication system may have at least one additionalcomputer device that may be coupled to at least one of the computerdevices of the first plurality or second plurality of computer devicesand that may incorporate a software-based or hard-ware based SessionInitiation Protocol (SIP) voice over Internet protocol (VoIP) toseparate the setting up and tearing down of voice calls between SIPenabled voice endpoint devices. The at least one additional computerdevice may comprise, for example, a VoIP private branch exchange (PBX).At least one of the first computer devices may comprise a VoIP roomgateway that is operable to distribute communication data to multiplevoice terminals or VoIP voice endpoints installed in patient rooms andhallways.

The first plurality of computer devices may be interconnected logicallyand/or physically in a tiered architecture arrangement to provide faultisolation among the tiers so that faults occurring in computer devicesof one tier don't affect the operability of computer devices in othertiers and/or so that faults occurring in any of the second plurality ofcomputer devices don't affect the core nurse call functionality of thefirst plurality of computer devices.

At least one of the tiers in such an arrangement may comprise a subsetof the first plurality of computer devices that are associated with apatient room. Another of the tiers in such an arrangement may comprise asubset of the first plurality of computer devices that are associatedwith a nursing unit having a plurality of patient rooms.

At least one computer device of the first plurality of second pluralityof computer devices may comprise a server that is equipped withRedundant Arrays of Independent Disks or Drives (RAID), redundant powersupplies, and/or clustering failover capability. At least one computerdevice of the first plurality of second plurality of computer devicesmay comprise broker service software that may be operable to monitorother services on the first plurality and/or second plurality ofcomputer devices and that may repair or restart faulty services.

Additional features, which alone or in combination with any otherfeature(s), such as those listed above, may comprise patentable subjectmatter and will become apparent to those skilled in the art uponconsideration of the following detailed description of variousembodiments exemplifying the best mode of carrying out the embodimentsas presently perceived.

BRIEF DESCRIPTION OF THE DRAWINGS

The detailed description particularly refers to the accompanyingfigures, in which:

FIG. 1 is a block diagram showing various components of a nurse callsystem, some of which are included as a part of a healthcarecommunication system according to this disclosure;

FIG. 2 is a block diagram showing a master console of the nurse callsystem coupling the nurse call system to other computer devices includedin a computer network of the healthcare facility;

FIG. 3 is block diagram showing nurse call systems of various nursingunits of a healthcare facility coupled to each other and coupled toother computer devices of the healthcare facility; and

FIG. 4 is a block diagram showing a number of software modulesassociated with an advanced services system of the healthcarecommunication system, the software modules having being communicativelycoupled to a master station and to other graphical audio stations of thenurse call system so that software plug-ins are distributable to themaster a station and to the other graphical audio stations to provideadditional functionality to these devices.

DETAILED DESCRIPTION

A healthcare communication system 20 includes a plurality of graphicalaudio stations 22 and a master station or console 24 which arecommunicatively coupled as shown diagrammatically in FIG. 1. Many of thestations 22 are located in patient rooms and are mounted, for example,to a wall of the respective room or to a headwall unit that, in turn, ismounted to a wall of the respective room. Stations 22 may be mounted toother architectural support structures, such as service chases orcolumns just to name a couple. Stations 22 may be located in other areasof the healthcare facility as well, such as in staff work areasincluding, for example, hallways and staff lounges. The stations 22located in patient rooms may sometimes be referred to herein as patientstations 22, whereas the stations 22 located in staff work areas may besometimes be referred to herein as staff stations 22. The functionalityof stations 22 described herein is applicable to all stations 22regardless of whether the station 22 is a patient station 22 or a staffstation 22, unless specifically noted otherwise.

Patient stations 22 communicate bidirectionally (e.g., two-waycommunication) with an input/output (I/O) circuit 27 which is locatedwithin a housing 26 mounted near a dome light assembly 28. Thebidirectional communication is indicated diagrammatically in FIG. 1 bydouble headed arrow 30. I/O circuit 27 is also shown diagrammatically inFIG. 2. Dome light assemblies 28 are typically mounted outsiderespective patient rooms near the doorways of the rooms and are readilyvisible to caregivers in the hallway to determine whether any calls orother events indicated on the dome light are occurring within theassociated room. Thus, housings 26 with I/O circuit 27 therein aremounted generally at these same locations outside patient rooms.Additional details of the dome light assemblies 28, housing 26, andcircuit board 27 are provided in U.S. Provisional Patent Application No.61/066,883 which was filed Feb. 22, 2008, which was titled “IndicatorAssembly for Healthcare Communication System,” and which is alreadyincorporated by reference herein.

A 9-page electric circuit schematic illustrating one possible electriccircuit implementation of one embodiment of the circuitry of dome lightassembly 28 is shown in FIG. 12 of U.S. Provisional Patent ApplicationNo. 61/066,877, which was filed Feb. 22, 2008, which was titled“Distributed Healthcare Communication System,” and which is alreadyincorporated by reference herein. In one embodiment, dome light assembly28 is, for example, an International Business Machines (IBM) Part No.43T1899 dome light fixture. A 55-page electric circuit schematicillustrating one possible electric circuit implementation ofinput/output (I/O) circuit 27 according to this disclosure is shown inFIG. 15 of U.S. Provisional Patent Application No. 61/066,877 which isalready incorporated by reference herein. In one embodiment, I/O circuit27 is, for example, an IBM part no. 43T2063 IO Board. In some Appendicesof the written description of U.S. Provisional Patent Application No.61/066,877, I/O circuit 27 may be referred to as an I/O board or an I/Ocircuit board. However, this is not to imply that all circuit componentsof the circuitry of I/O circuit 27 need to be on a single circuit board,but that is certainly one possibility. Thus, in some contemplatedembodiments I/O circuitry 27 may be distributed among numerous circuitboards, and in other contemplated embodiments some or all of thecomponents of circuit 27 may not be on any circuit board at all. Whileillustrative circuit 27 is located in housing 26, it is within the scopeof this disclosure for various components of circuit 27 to be located inseparate housings.

The I/O circuit 27 of assembly 28 communicates bidirectionally with aPower over Ethernet (PoE) switch 32 as indicated diagrammatically inFIG. 1 by double headed arrow 34. PoE switch 32 communicatesbidirectionally with master station 24 as indicated diagrammatically bydouble headed arrow 36. Suitable PoE switches are available from avariety of suppliers and may include, for example, the PoE switchmarketed by Hill-Rom Company, Inc. in connection with its NaviCare®Nurse Call™ system or such as one or more of the various Dell PoEswitches marketed under the PowerConnect™ brand name. Optionally, anexternal power supply is coupled to PoE switch 32 to provide back uppower to PoE switch 32 in the event that an internal power supply of PoEswitch 32 fails. One example of a suitable external power supply isOptimal Power part number OPN300-48SN which is coupled to the PoE switch32 using an Optimal Power part number OPNC30148 cable. While only onepatient station 22 is shown in FIG. 1 as being communicatively coupledto master station 24, via the I/O circuit board 27 of assembly 28 andvia PoE switch 32, it will be appreciated that system 20 may havenumerous such patient stations 22 that may communicate with masterstation 24 via respective I/O circuit boards 27 and via PoE switch 32.

Typically, all of the patient stations 22 of a nursing unit communicatewith the same master station 24. The master stations 24 and graphicalaudio stations 22 of different nursing units may be coupled together byinterconnecting the respective PoE switches as indicateddiagrammatically in FIG. 3 via dotted lines 38. In this way, informationcan be shared, and communications established, between computersdevices, such as stations 22, of different nursing units. This is animprovement over prior art systems having the master stations and audiostations of each nursing unit isolated and unable to communicate withthe master stations and audio stations of other nursing units.

In some embodiments, such as the one shown in FIG. 1, system 20 includesbed connector units 40, each of which is communicatively coupled to anassociated hospital bed 42 as shown diagrammatically in FIG. 1 via lines44. Bed connector units 40 are, in turn coupled to a respective circuitboard 27 as indicated diagrammatically in FIG. 1 via lines 46. In someother embodiments, bed connector units 22 may be coupled to graphicalaudio station 22 which communicates with the corresponding circuit board27 in the way that bed connector units 40 are shown coupling tographical audio stations 124 (discussed in further detail below) viadiagrammatic lines 146 in FIG. 1. In still other embodiments, bedconnectors units 40 may be integrated into a common housing of graphicalaudio stations 22 (and stations 124 as well) in the way that connectors224, 225 are integrated into standard audio station 222 as shown in FIG.2. Stations 222 are discussed in further detail below.

One version of bed connector unit 40 is referred to in some of theAppendices of the written description of U.S. Provisional PatentApplication No. 61/066,877 as a Bed Interface Unit (BIU) which, in oneembodiment, includes a 37-pin connector to attach to a bed cable,includes another connector for attachment of a call pendant or pillowspeaker unit, and an includes a button that can be manually pressed tosend and/or cancel a nurse call. Another version of a bed connector 228is referred to as a Silver Plate in some of the Appendices attached inU.S. Provisional Patent Application No. 61/066,877 and is shown in FIG.2. Bed connector 228 is a low cost connector which includes only aconnector to which bed 42 couples via a suitable connection cord. Insome embodiments, beds 42 comprise one or more of the beds marketed byHill-Rom Company, Inc. under the brand names TOTALCARE®, VERSACARE®,ADVANCED-1000™, CCUII™ and ADVANTA®.

Many other types of devices in a patient room may also couple to arespective I/O circuit 27 mounted near the corresponding dome lightassembly 28 to communicate with master station 24 and, if desired, othercomputer devices of the a computer network of the healthcare facility.For example, in FIG. 1, an equipment connector 48 to which patient careequipment, such as patient monitoring equipment, may be connected iscoupled to the I/O circuit 27 as indicated diagrammatically bydouble-headed arrow 50 and a wall-mounted nurse call switch 52 which maybe mounted in a lavatory of the patient room, for example, is coupled tothe circuit board 27 of assembly 28 as indicated diagrammatically bydouble-headed arrow 54. Furthermore, a wireless receiver 56, whichillustratively is an infrared receiver that receives wireless signals 60from locating-and-tracking badges 58 worn or carried by caregivers iscoupled to the I/O circuit 27 of assembly 28 as indicateddiagrammatically by double-headed arrow 62. It is also contemplatedherein that a smoke alarm 64 is coupleable to the I/O circuit 27 ofassembly 28 as indicated in FIG. 1 by double headed arrow 66.

As previously mentioned, some graphical audio stations 22 are located instaff work areas and are referred to as staff stations or consoles 22.In FIG. 1, a first staff station 22 communicates bidirectionally withPoE switch 32 via a communications link 68 and a second staff station 22communicates bidirectionally with PoE switch 32 via a communicationslink 70. The first staff station 22 is mounted to a wall, for example,whereas the second staff station 22 has a graphical display screenmodule 72 connected to a base module 74 which includes a telephone handset 76. The master station 24 shown in the FIG. 1 example also has agraphical display screen module 72 connected to a base module 74 whichhas a telephone handset 76. The FIG. 1 example also shows a personalcomputer 78 which cooperates with the associated display screen module72 to provide the master station functionality. In other embodiments,personal computer 78 is the only computer device included in masterstation 24 while, in still other embodiments, personal computer 78 isomitted. Thus, depending upon the manner in which a graphical displaymodule 72 is programmed it can serve as a patient station 22, a staffstation 22 or as a master station 24. When serving as a staff station 22or a master station 24, module 72 can be coupled to base module 74, ifdesired. The display screen of module 72 is approximately a 10 inchdisplay screen in some embodiments and therefore is larger than the LCDscreen used in, for example, the COMLINX® system.

Each of the communications links 30, 34, 36, 44, 46, 50, 54, 60, 62, 66shown diagrammatically by lines or arrows in FIG. 1 may include wiredlinks and/or wireless links and/or combinations thereof, along withassociated connectors. For example, with regard to links 44 between beds42 and bed connector units 40, known cables having 37-pin connectors (orsimilar connectors) may provide these links 44. Alternatively oradditionally, some of links 44 may be wireless links, in which case, therespective beds 42 and units 40 have appropriate wireless transmitterand wireless receiver circuitry, which may be in the form of a wirelesstransceiver. Such wireless communication between beds 42 and units 40 isdiscussed, for example, in U.S. Pat. No. 7,319,386 and in U.S. PatentApplication Publication No. 2007/0210917 A1, both of which are herebyincorporated herein by this reference.

While this disclosure contemplates that the data formatting for the datatransmitted over any of links 30, 34, 36, 44, 46, 50, 54, 60, 62, 66,68, 70 may be according to any suitable data formatting protocol, in oneembodiment, the data formatting protocol is according to the protocoldiscussed in detail in the “Project NCM II, Interface DesignSpecification, NPD05514” document which is attached to U.S. ProvisionalPatent Application No. 61/066,877 as Appendix 1 and which is consideredpart of the written description of that provisional patent applicationand of this patent application via the incorporation by referencepreviously made in this application of U.S. Provisional PatentApplication No. 61/066,877. In general, the protocol described inAppendix 1 of U.S. Provisional Patent Application No. 61/066,877 usesextensible markup language (XML) strings to transfer data. This protocolis sometimes referred to as the Palmetto Protocol and is sometimesreferred to as the XML protocol herein and in some of the documents inthe Appendices of the written description of U.S. Provisional PatentApplication No. 61/066,877. It is also contemplated that thecommunication protocol for links 30, 34, 36, 44, 46, 50, 54, 60, 62, 66may be according to any suitable protocol such as the TCP/IP protocol,the RS-232 protocol, the RS-422 protocol, the RS-423 protocol, or theRS-485 protocol, or similar such protocols, and such as wirelessprotocols including any of the IEEE 802.11_(x) protocols (where xrepresents the various revision levels a, b, c, d, e, g and so forth ofthe 802.11 protocol), the Bluetooth protocol, the Zigbee protocol, orsimilar such wireless communication protocols.

In one embodiment, links 44, 46, 54, 62, which are the communicationslinks associated with a patient room that communicate between devices inthe patient room and the I/O circuit board of dome light assembly 28,are according to the RS-485 protocol, whereas links 34, 36, 68, 70,which are the links to and from PoE switch 32, are according to theTCP/IP protocol. The devices that communicate over these various linksare configured and programmed appropriately for the required RS-485 orTCP/IP protocol, as the case may be.

It should be noted that, in one contemplated embodiment, link 30comprises a coupler that couples to a PoE port of the respective I/Ocircuit 27 such that communications over link 30 are transmittedaccording to the TCP/IP protocol and I/O circuit 27 provides feedthrough of any data, including communication data such as voice data,communicated between station 22 and PoE switch 32. Because stations 22communicate according to the TCP/IP protocol, staff stations 22 arecoupleable to PoE switch 32 without the use of an intervening I/Ocircuit 27, if desired. As to the various devices coupled to I/O circuit27 other than station 22, the circuitry of I/O circuit 27 operates toconvert the data from these various devices according to theirdevice-specific communication protocols (e.g., serial links to stations122, 222; locating and tracking receiver 56 room bus protocol; bedconnector 40 room bus protocol; and serial to dome light protocol) intothe TCP/IP protocol for subsequent transmission to the PoE switch andultimately to the master station 24 and beyond, if desired.

According to this disclosure, system 20 is scaleable such that basic,intermediate, and advanced nurse call systems can be created dependingupon the particular requirements of a particular healthcare facility.The graphical audio stations 22 discussed herein are associated with anadvanced nurse call system and are referred to in several of thedocuments of the Appendices of U.S. Provisional Patent Application No.61/066,877, which are considered part of this written description viaincorporation by reference, as an advanced graphical audio station(AGAS) and are referred to in the documents of the Appendices of U.S.Provisional Patent Application No. 61/145,306, which is also consideredpart of this written description via incorporation by reference, as aGraphical Room Station 10 (GRS-10). A 42-page electric circuit schematicillustrating one possible electric circuit implementation of oneembodiment of an advanced graphical audio station (AGAS) 22 according tothis disclosure is shown in FIG. 11 of U.S. Provisional PatentApplication No. 61/066,877. In one embodiment, audio graphical station22 is an IBM part no. 43T2058 station.

A graphical audio station 122, shown in FIG. 1, provides mid-range orintermediate functionality and includes a smaller graphical displayscreen 124 than the display screen of stations 22. This type ofintermediate station 122 is referred to in the documents of theAppendices of U.S. Provisional Patent Application No. 61/066,877 as agraphical audio station (GAS) and in the documents of the Appendices ofU.S. Provisional Patent Application No. 61/145,306 as a Graphical RoomStation 5 (GRS-5). FIGS. 13 and 14 of U.S. Provisional PatentApplication No. 61/066,877 cooperate to provide an electric circuitschematic illustrating one possible electric circuit implementation ofone embodiment of graphical audio station (GAS) 122. Graphical audiostation 122 in one embodiment comprises IBM part nos. 43T2071 and43T2067.

A standard audio station 222, shown in FIG. 2 and referred to in thedocuments of the Appendices of U.S. Provisional Patent Application No.61/066,877 as a standard audio station (SAS) and referred to in theAppendices of U.S. Provisional Patent Application No. 61/145,306 asStandard Room Station (SRS) has no graphical display screen. A 20-pageelectric circuit schematic illustrating one possible electric circuitimplementation of one embodiment of standard audio station 222 is shownin FIG. 16 of U.S. Provisional Patent Application No. 61/066,877.Graphical audio station 222 in one embodiment comprises IBM part no.43T2082. Additional details of stations 22, 24, 122, 222 are provided ina U.S. Provisional Patent Application No. 61/066,882 which was filedFeb. 22, 2008, which is titled “User Station for HealthcareCommunication System,” and which is already incorporated by referenceherein.

Standard audio stations 222 are a low cost offering that provides callcancel, call placement, reception for signals from badges 58, and voicecommunication functionality. As mentioned already, stations 222 do nothave a graphical display. Stations 222 connect to the I/O circuit boardof assembly 28 via an RS-485 connection 30. Stations 222 can beconfigured as a patient station, staff station, or visitor station. Asindicated in FIG. 2, beds 42 may couple to stations 222 via an audiostation bed connector (ASBC) 224. Also, pillow speaker units 226 and/ora call switch 52 (e.g., a call cord in some instances) may couple tostation 222, such as by coupling to a connector 225 included as part ofstation 222. It is contemplated that bed connector 224 can be integratedinto station 22 and thus, in FIG. 2, reference numeral 224 is used todenote such an integrated connector 224 of station 222 as well as theseparate bed connector block 224. In the FIG. 2 example, however, bed 42is coupled to a Silver Plate 228 which is, in turn, coupled to theassociated I/O board 27. The term “Silver” refers to the general colorof the plate, not its material.

While FIG. 2 shows one block representative of I/O circuit 27 and showstwo separate dome light assemblies 28 linked to it via unnumbereddouble-headed arrows, it should be appreciated that in some embodimentseach assembly 28 has its own I/O circuit 27 as discussed previously.However, this need not be the case in all instances and therefore,having I/O circuits 27 located elsewhere in system 20 is within thescope of this disclosure. As further shown in FIG. 2, bed connector 40is coupled to I/O circuit board 27 via an RS-485 communications link230. FIG. 2 also shows station 22 coupled to I/O circuit 27 via link 30,PoE switch coupled to I/O circuit 27 via link 34, nurse call switch 52coupled to I/O circuit 27 via link 54, a wireless receiver 56 coupled toI/O circuit 27 via link 62, and PoE switch 32 coupled to master station24 via link 36. A staff station 22 is also shown in FIG. 2 incommunication with master station 22 via link 70. While link 70 is showndirectly between master console 24 and staff console 22, this isintended to be representative of a “logical link” to indicate that staffstations 22 communicate all received commands to the master station 24and receive information about all other devices, such as patientstations 22, of the nursing unit from master station 24. Thus, staffstations 22 communicate with master station 24 via PoE switch 32.

Intermediate level audio stations 122 are a mid range offering thatprovides all of the functionality that a standard audio station 222provides. In addition, stations 122 have small touch screen displays 124that allow for monitoring calls, monitoring other types of alerts, viewthe location of staff, call located staff, change bed status (e.g.,clean or dirty status), enable and disable nurse calls and alerts for alocation or for a nursing unit. Unlike station 222, station 122 runs aLinux operating system (OS) that drives the graphical display andresponds to user interaction. The content for display 124 of station 122is controlled by the associated I/O circuit board 27 and by advancedservices which are resident on other computer devices of system 20 aswill be further discussed below. For base functionality, the I/O circuitcontrols the display of station 122 by sending XML strings to station122. The circuitry of station 122 interprets those strings and displaysa corresponding user interface (UI). If an advanced functionality isrequested by station 122, the I/O circuit forwards the request for theadvanced service(s) and the computer device of system 20 having theadvanced service(s) replies back with the content in the appropriatelyformatted XML string.

In the illustrative example, advanced level audio stations 22, 24provide all of the functionality of stations 122 except stations 22couple to bed connectors 40, 224 via I/O circuits and not directly.However, in other embodiments contemplated herein, either of connectors40, 224 may be integrated into station 22 or connected thereto in amanner similar to which they are integrated or connected in stations122, 222 as described above. Stations 22, 24 also run a Linux OS, but itis written in C# programming code and executed under Mono, an opensource implementation of the .NET framework maintained by Novell. Thispermits some code sharing between base and advanced systems as discussedin more detail below, and in the Appendices of U.S. Provisional PatentApplication No. 61/066,877 which are already incorporated by referenceherein.

In broad general terms, it is the stations 22, 24 which are configuredto communicate with various other computer devices, such as servers,included in the Ethernet of a healthcare facilities' system 20 and it isthis additional communication capability that distinguishes thesedevices as advanced graphical audio stations. According to thisdisclosure, the components of system 20 which cooperate to provide ahealthcare facility with a nurse call system are referred tocollectively as a “base nurse call system.” Thus, stations 22, 122, 222and I/O circuit 27, dome light assemblies 28, and any of the equipmentdescribed above that is capable of providing a nurse call signal, aswell as the associated master station 24 and PoE switch 32 along withany of the communication links interconnecting these components, areamong the components which comprise a “base nurse call system” accordingto this disclosure. Staff stations 22, if present, are also consideredto comprise part of the base nurse call system.

If voice communication capability among stations 22, 24, 122, 222 is tobe a function of the nurse call system, then a Voice over InternetProtocol (VoIP) sever 250 is also included in the base nurse call systemand is coupled to PoE switch 32 via a TCP/IP communications link 252 asshown in FIG. 2. Server 250 facilitates communication between which everof stations 22, 24, 122, 222 are present in the system 20. Server 250 isconfigured to translate system operations and communications to thecorresponding messages that then control endpoint devices, such asstations 22, 122, consoles 24, or room input/output circuits 27. Assuch, server 250 includes a soft telephony switch and other associatedcomponents. Server 250 may also provide integration with the hospitaltelecommunications structure (e.g., PBX or other voice communicationsystem), although some other server may do so as well as is discussedbelow. In the illustrated embodiment, server 250 is a Windows serverrunning 3CX. The components of the base nurse call system ofillustrative system 20 are compliant with Underwriter's Laboratories1069 standard according to this disclosure. This is not to imply thatthese components may not also be compliant with other standards relatingto nurse call systems or relating to some other aspect of these devices.

According to this disclosure, stations 22, 24 also permit users toperform functions associated with an “advanced services system.” Thesoftware code, such as applets or plug-ins, that provides stations 22with these advanced functions may be communicated from various servers,or similar such computer devices discussed below, to stations 22 viastations 24, PoE switch 32, I/O boards 27, and the associated links 30,34, 36. Thus, stations 22, 24 are dependent upon some devices that arenot part of the base nurse call system, but instead are part of theadvanced services system, to provide the advanced functionality tostations 22, 24. However, if these other devices are inoperable orcommunications with such devices of the advanced services system cannotbe established or is otherwise faulty, the base nurse call systemfunctionality is still able to operate. Thus, functionally, the basenurse call system is isolated from the advanced services system from ahardware standpoint and from a software standpoint.

System 20 includes an enterprise server 260 which is included as part ofthe advanced services system as shown in FIGS. 1-3. Server 260 links tothe nurse call portion of system 20 to provide advanced servicesthereto. A communication link 262 exists between server 260 and masterstation 24 via an appropriate switch device, such as a PoE switch 32 orother type of switch. Multiple master stations 24 may connect to server260 via a switch 32 as shown in FIG. 3. As shown in FIG. 1, a privatebranch exchange (PBX) 264 may be coupled to server 260 via a VoIPcommunications link 266 to permit two-way voice calls to be placed overthe public switched telephone network (PSTN) 268 to telephones outsidethe healthcare facility from graphical audio stations 22, 24, 122 byappropriate use of user inputs of user interfaces displayed on stations22, 24, 122 as part of an associated advanced service. Two-way voicecalls may be made similarly via server 260 and PBX 264 to wireless voicecommunication devices, such as a wireless communication badge 270 (e.g.,a Vocera™ badge) or a wireless hand set 272, shown in FIG. 3, inresponse to appropriate use of the user interfaces of stations 22, 24,122. Text messages may be sent to devices both inside and outside thehealthcare facility via these same communications links in response touse of the user interfaces of stations 22, 24, 122. PSTN 268 is intendedto represent, diagrammatically, a variety of telecommunication devices,including analog and digital devices, fixed telephones and mobile orcellular devices, personal data assistants (PDAs), pagers and the like.

As shown in FIG. 2, a non-exhaustive list of examples of other computerdevices, each of which is optional according to this disclosure, thatcommunicate via appropriate communications links with enterprise server260 and therefore, with associated master stations 24 of one or morenurse call systems, include a database server 280; one or more thirdparty servers 282; a first wireless communications server 284 formanaging communications to and from wireless telecommunications devices;a second wireless communications server 286 for handling communicationsto and from other devices such as wireless badges for locating andtracking of staff members; a user authentication server 288 for managinguser accounts, passwords, and user authorization; a workflow server 290,which facilitates integration with workflow software systems; a hospitaladministrative client 292 for conducting administrative tasks relatingto patients and staff, such as adding patients and assigning staff topatients; and a status or reports server 294 for managing displays andreports of calls and notifications for one or more locations in thefacility. An electronic status board 296 may also be coupled to server260 as shown diagrammatically in FIG. 2. Status board 296 is operable todisplay locations within the facility and current information aboutthem, such as active calls, bed status information, staff located in thehealthcare facility, and staff assigned to the location.

While the term “server” is used herein, it will be understood by thoseskilled in the art that the functionality represented or performed bydevices referred to as “severs” may comprise and be performed by anysuitable computer device having software programs or services that maybe resident and/or executable by any computer, device or equipment inthe system or more than one computer, device or equipment in thenetwork. Thus, there term “server” is intended to broadly encompass anycomputer device that is capable of performing the mentioned functions.

In the illustrated embodiment, server 284 is configured to providecommunication and configuration for wireless devices using EmerginWireless Office; server 286 is configured to provide communication andconfiguration for wireless Vocera devices; server 290 is configured tointerface with or be included as part of a Hill-Rom® NaviCare™ system toreceive and process task assignment and completion information. Plug-insor applets or similar such software code may be resident on any ofservers 260, 282, 284, 286, 288, 290, 292, 294, for example, and beretrieved by stations 22, 24 via server 260 as part of the “advancedservices system” functionality. The software to display a particularuser interface associated with an advanced service on a particularstation 22, 24 which is operated by a user in a manner resulting in therequest of the advance service may be executed on a device other thanthe one that requested it. For example, such advance service softwaremay be executed by the circuitry of a master station 24 or I/O circuit27, but yet the resulting user interface is display on one of stations22. Additional details of the advanced services functionality are shownand described in the “Code Blue Advanced System Software, ArchitecturalDesign Specificaiton, NPD05503” document attached to U.S. ProvisionalPatent Application No. 61/066,877 as Appendix 2 and is considered partof the written description of this patent application via incorporationby referenced of U.S. Provisional Patent Application No. 61/066,877.Further details of system 20 and its functionality are also provided inthis same U.S. Provisional Patent Application No. 61/066,877.

Referring now to FIG. 4, logical interconnections between varioussoftware modules of the advanced services system and the base nurse callsystem are illustrated diagrammatically. Software modules are sometimesreferred to herein as just modules. A dashed line 300 represents thelogical division between the base nurse call system, which is to theleft of dashed line 300, and the advanced services system, which is tothe right of dashed line 300. As mentioned above, plug-ins or applets orsimilar such software code or modules may be resident on any of servers260, 282, 284, 286, 288, 290, 292, 294, for example, and be retrieved bystations 22, 24 via server 260 as part of the “advanced services system”functionality. Server 260 includes a device service module 302 whichprovides system 20 with a device service.

The primary console 24 is configured to communicate with a specific IPaddress and port which are associated with the device service. Thedevice service accepts any incoming connections from one or more primaryconsoles 24 and monitors the consoles 24 to determine if any advancedservice functionality is to be delivered to a particular console 24,possibly for subsequent distribution by console 24 to other devices,such as stations 22, 122 and circuit 27, for example. The variousactivities occurring in the base nurse call system are communicated byconsoles 24 to the device service which operates to relay relevant datato any other advanced service or any other computer device which havesubscribed to receive such data or to which the device service publishessuch data.

In the illustrative example, the advanced services system includes aconfiguration service module 304, an alert/call service module 306, acommunication service module 308, a location service module 310, a staffservice module 312, a roll services module 314, a broker/supervisorservice module 316, a logging service module 318, a patient servicemodule 320, a licensing service module 322, an HL7 service module 324,and a legacy integration service module 326. Legacy integration servicemodule 326 provides connectivity to existing nurse call systems, such asthe COMLINX® system, which is represented in FIG. 4 by NCM 4.0 block330. Illustrative, module 326 communicates bidirectionally with theillustrative legacy nurse call system 330 via a NavManager 328. Thevarious modules 302, 304, 306, 308, 310, 312, 314, 316, 318, 320, 322,324, 326 post data to and retrieve data from a data base 332. Database332 may reside on one or more separate database servers or may beincluded on server 260 or may be included in a database server cluster,for example.

As mentioned above, device service module 302 is resident on server 260.However, it is within the scope of this disclosure for any one or moreof service modules 302, 304, 306, 308, 310, 312, 314, 316, 318, 320,322, 324, 326 to be resident on any one or more of servers 260, 282,284, 286, 288, 290, 292, 294. In one embodiment, however, all of servicemodules 302, 304, 306, 308, 310, 312, 314, 316, 318, 320, 322, 324, 326are resident on server 260. The listed service modules and/or otherservice modules may also be resident on VoIP server 250 in otherembodiments.

If one of the advanced services needs to transmit commands orinformation to a device of the base nurse call system, for example, ifthe advanced service needs to communicate to primary console 24 an alertcondition occurring in some other portion of system 20 or the advancedsystem needs to command the I/O circuit 27 to reset, device service 302sends to the primary console 24 the data or command through a TCP/IPsocket connection of the primary console 24 using the XML over TCP/IPprotocol discussed above and in the Appendices of U.S. ProvisionalPatent Application No. 61/066,918 which is already incorporated byreference herein.

This disclosure contemplates a second line of communication to devicesof the base nurse call system, which second line of communication isthrough a defined interface. The base application running on stations22, 24 is written in C# using Mono on Linux as mentioned previously.Advanced features are enabled on stations 22, 24 by pushing advancedplug-ins down to stations 22, 24 and having them dynamically loaded inseparate application domains when needed. The description below of howplug-ins operate on one of stations 22 is applicable to other stations22, 24 as well, and also to stations 122 in some embodiments.

A logical representation of this second line of communication isillustrated in FIG. 4 with regard to graphical audio station 22. Asshown in FIG. 4, firmware 350 is provided in station 22 on an embeddedcomputing platform. The firmware 350 provides station 22 with its corenurse call functionality. Station 22 also has advanced services systemintegration software 352 that is compatible with the server computerplatform of the advanced services system and that receives the varioussoftware plug-ins from the advanced services system. It should beappreciated that the various lines in FIG. 4 interconnecting integrationsoftware 352 with advanced services 306, 308, 310, 312, 320, 322 arelogical connections, not hardware connections.

Station 22 has an interface 354 between firmware 350 and integrationsoftware. Interface 354 is a control interface and, in the illustrativeembodiment, is not intended to transfer data. Data transfer throughinterface 354 may occur in other embodiments, however. Interface 354provides the ability of station 22 to load and unload one or moreplug-ins, start and stop the functionality of the plug-ins, and show andhide the plug-in's user interface, if the plug-in has one associatedwith it.

When a new device, such as one of stations 22, 24 or I/O circuit 27, isadded to the system, server 260 pushes one or more software plug-ins, asappropriate, from one or more of advanced service modules 302, 304, 306,308, 310, 312, 314, 316, 318, 320, 322, 324, 326 in response to server260 becoming aware of the new device. The one or more software plug-insare installed and become operational when launched, such as when a userfirst uses an associated advanced service on the device. Future updatesand upgrades of the plug-ins pushed to the new device are also sent tothe new device automatically.

According to this disclosure, system 20 includes a hospitaladministrative client computer 360 as shown in FIG. 4. Computer 360 isused, for example, for patient and staff administrative tasks, such asadding patients, discharging patients, assigning staff members topatients and/or locations, changing device assignment for staff, and soforth. Computer 360 is a so-called “rich client” deployable and updatedvia a central server. Multiple computers 360 may be included in system20 and have any or all of these functions.

Computer 360 may also be used to distribute software upgrades andupdates throughout system 20, including to devices of the base nursecall system. The software upgrades and updates are distributable all atonce to the multiple devices using computer 360. This eliminates theneed to load software upgrades and updates on individual computerdevices of the base nurse call system. Microsoft ClickOnce applicationsoftware is an example of software that computer 360 may use toimplement this manner of software upgrades and updates.

It should be appreciated that, as to the base nurse call systemcomponents, the software upgrades and updates distributed by computer360 relate only to the advanced functionality of the base nurse callsystem and not the core nurse call functionality of the base nurse callsystem. That is, the software updates and upgrades do not change any ofthe firmware 350 of the embedded computer platforms of stations 22, 24or other devices of the base nurse call system, such as circuit 27. Byisolating the core nurse call functionality from the advanced servicesfunctionality of stations 22, 24 in this way, recertification forcompliance with the UL-1069 standard is not needed when any of theadvanced services are upgraded or updated or additional advancedservices added. Thus, regulated functionality of the base nurse callsystem is isolated on a software basis and/or a hardware basis from theadvanced services that are run on some of the devices of the base nursecall system.

The architecture of system 20 allows a user to have access to both thecore nurse call functionality and other optional features that areavailable seamlessly via the embedded computing platform of stations 22,24, and stations 122 in some embodiments. By use of software plug-ins toaccomplish this, stable software that is stored locally is combined withthe optional software of the plug-ins, which is applied to the embeddedplatform as needed. For example, a portion of a user interface on thegraphical display screens of stations 22, 24, 122, are generated withlocal software, whereas other user interfaces, or portions thereof, aregenerated by the software plug-ins but this is generally unknown andundetected by the user.

In one embodiment, server 260 is a Windows-based server platform capableof running .NET 3.0 in order to support Windows CommunicationsFoundation (WCF), a service architecture framework provided byMicrosoft. Advanced service modules 302, 304, 306, 308, 310, 312, 314,316, 318, 320, 322, 324, 326 are implemented in WCF and communicateusing deployment-time configured protocols. In the case in which all ofservice modules 302, 304, 306, 308, 310, 312, 314, 316, 318, 320, 322,324, 326 are running on the same machine, such as server 260, eachservice communicates to the others using Named Pipes which is anefficient means of communication and supports state machine deployment.In other instances, service modules 302, 304, 306, 308, 310, 312, 314,316, 318, 320, 322, 324, 326 are configured to communicate via a binaryTCP/IP protocol, using Microsoft Message Queuing (MSMQ) to providesubstantially guaranteed delivery, and Hypertext Transfer Protocol(HTTP) when providing compatibility to Mono and other third partyintegrations. Each service modules 302, 304, 306, 308, 310, 312, 314,316, 318, 320, 322, 324, 326 may be configured to communicate over morethan one binding in order to support simultaneous usage from legacysystems as well as base nurse call system disclosed herein. Additionaldetails of the service modules 302, 304, 306, 308, 310, 312, 314, 316,318, 320, 322, 324, 326 are provided in the document attached asAppendix 2 to U.S. patent application Ser. No. 61/066,918 which isalready incorporated by reference herein.

System 20 is configured in a tiered architecture arrangement toincorporate several levels of fault tolerance, redundancy, and selfmonitoring to lessen the impact of component failures on users of thesystem. System 20 is tiered at several levels to achieve this faulttolerance. For example, the room gateway (e.g., I/O circuit) hassufficient computing power and functionality to allow a patient,caregiver, or monitoring device to initiate an alert even if there is amajor fault in a portion of the system 20 not associated with theparticular patient room. This aspect of system 20 may be referred to asroom survivability. Another level of the tiered architecture arrangementis that the master nurse station console 24 has sufficient computingpower and functionality to run an entire nursing unit with all the corenurse call system functionality, even if server 260 has a major failure.This aspect of system 20 may be referred to as nursing unitsurvivability.

At the enterprise level of system 20, which includes, but is not limitedto, the devices associated with the advanced services system, there aremany hardware and software mechanisms included throughout the systemthat allow some or all of the system 20 to remain functional despite theoccurrence of a variety of faults. For example, any one or more ofservers 250, 260, 282, 284, 286, 288, 290, 292, 294 may be equipped withat least one of Redundant Arrays of Independent Disks or Drives (RAID),redundant power supplies, or clustering failover capability. Brokerservice module 316 operates to monitor the health of the other servicemodules 302, 304, 306, 308, 310, 312, 314, 318, 320, 322, 324, 326 andis operable to repair or restart faulty services, in some instances.

As mentioned above, system 20 comprises a software architecture thatincorporates distributed Publish and Subscribe (PubSup) datacommunication technology. This allows many services and applications toeasily communicate and share data with each other. The PubSub datacommunication technology allows this data sharing between softwareservices and applications on the same computing platform or between manycomputing platforms across a network. Each service or application, suchas one or more of service modules 302, 304, 306, 308, 310, 312, 314,316, 318, 320, 322, 324, 326, has the ability to publish or makeavailable its data to other services or applications (e.g., subscribers)that have a use for the data. As the data changes, the subscribers areautomatically updated.

Stations 22, 24, and stations 122 in some embodiments, as well as I/Ocircuit 27 each include auto-discovery technology, such as software,that allows these computer devices to discover their networkconnectivity settings, software modules, and other systemresponsibilities when first installed in system 20. Each of thesecomputer devices are configured with the auto-discovery technology atthe time of manufacture. When a device is installed, the auto-discoverysoftware of the device operates to automatically seek and initiatecontact with a device manager. The device manager, such as server 260,will then communicate appropriate network settings, transfer therequired software modules, and/or assign other responsibilities to thenewly installed device. That newly installed device is then operationalon system 20 once this information from the device manager is received.

According to this disclosure, in some embodiments, system 20incorporates software-based or hardware-based Session InitiationProtocol (SIP) voice over internet protocol (VoIP) technology toseparate the set up and tear down of voice calls between SIP enabledvoice endpoint devices. This is accomplished having a separate VoIPprivate branch exchange (PBX), such as PBX 264 (e.g., hard-ware based)or servers 250 284, 286 (software-based), that has connectivity to therest of system 20 and/or to PSTN 268. System 20 also incorporates a VoIProom gateway, such as I/O circuit 27, which can distribute voicecommunications to multiple voice terminals or VoIP voice endpointsinstalled in patient rooms and hallways.

As is apparent from the discussion above, some of the improvementsrealized by system 20 over prior art systems include the followingimprovements. The distributed architecture retains and preserves themost critical functionality at the local user level should a failureoccur in system 20 outside that local area, which lessens system wideimpact due to single points of failure. Distributing software updatesand upgrades from administration computer device 360 greatly reduces thetime required to perform updates and upgrades to numerous devices andlessens the chance that devices are not updated due to human error.Computer 360 permits a user to easily and quickly install softwareapplications on numerous devices. Also, software maintenance issimplified by having some updates and upgrades distributed automaticallywhen a particular application is launched. Use of software plug-insallows the core nurse call functionality software to be developed,built, and tested separate from the optional software. This lessens thechance of the core software being adversely affected by changes to theoptional software. It also allows the core software to remain morestable though product life cycle and reduce the number of regulatorysubmissions. It should be appreciated that various system embodimentsaccording to this disclosure may not be configured to have all of theimprovements mentioned above in this paragraph or even any of them.

Additional improvements realized by system 20 over prior art systemsinclude the following improvements. The fault tolerant, tieredarchitecture arrangement of system 20 increases reliability by reducingsingle points of failure in the system. It also allows a technician toperform maintenance on the system while impacting few or no other users.The PubSub technology allows communication and sharing to occur moreefficiently and makes software development easier and faster becauseindividual developers are able to focus on their particular softwareapplication or service. The auto-discovery technology eases installationand greatly reduces installation and repair times, as well aseliminating the need for the installation technician to connect to eachdevice, one at a time, to configure network settings and installsoftware. Having a separate SIP VoIP PBX allows the healthcare facilityto select from a variety of compliant PBX's on the market or to use onethe facility already possesses for their other voice systems. The SIPVoIP PBX also isolates less critical voice features from the core nursecall alert notification features. The flexibility to use either asoftware-based or hardware-based SIP VoIP PBX gives healthcarefacilities the option to install this functionality on existing serversor to use a high reliability hardware appliance to support voicefeatures of the system. Use of the VoIP room gateway gives thehealthcare facility the flexibility to select lower cost voice terminalswith limited functionality or higher cost VoIP voice endpoints with morefunctionality. It should be appreciated that various system embodimentsaccording to this disclosure may not be configured to have all of theimprovements mentioned above in this paragraph or even any of them.

Although certain illustrative embodiments have been described in detailabove, variations and modifications exist within the scope and spirit ofthis disclosure as described and as defined in the following claims.

1. A healthcare communication system comprising: a first plurality ofcomputer devices operable as a nurse call system, the first plurality ofcomputer devices having core nurse call functionality residing on anembedded computing platform, at least one of the first plurality ofcomputer devices having a graphical display screen, and a secondplurality of computer devices operable to provide the first plurality ofcomputer devices with additional functionality via software plug-insthat are transmitted to the first plurality of computer devices.
 2. Thehealthcare communication system of claim 1, wherein the graphicaldisplay screen has a user interface that, when used by a user, resultsin at least one of the software plug-ins being transmitted to at leastone of the first plurality of computer devices.
 3. The healthcarecommunication system of claim 2, wherein the at least one of the firstplurality of computer devices to which the at least one software plug-inis transmitted comprises at least one of a master station, a patientroom station located in a patient room of the healthcare facility, aninput/output (I/O) circuit that is coupled to the patient station, or astaff station located in a staff work area of the healthcare facility.4. The healthcare communication system of claim 1, wherein the at leastone software plug-in is operable to change the user interface of thegraphical display screen to a different user interface.
 5. Thehealthcare communication system of claim 1, wherein the second pluralityof software devices are configured such that at least one of thesoftware plug-ins is transmitted to the first plurality of computerdevices on an as needed basis as dictated by use of at least one of thefirst plurality of computer devices.
 6. The healthcare communicationsystem of claim 1, wherein the second plurality of software devices areconfigured such that at least one of the software plug-ins istransmitted to some or all of the first plurality of computer devices inresponse to use of at least one of the second plurality of computerdevices.
 7. The healthcare communications system of claim 1, whereinsoftware upgrades or updates installed on at least one of the secondplurality of computer devices are distributed automatically to at leastsome of the first plurality of computer devices.
 8. The healthcarecommunications system of claim 7, wherein the software upgrades orupdates are also distributed automatically to at least one othercomputer device of the second plurality of computer devices.
 9. Thehealthcare communications system of claim 1, wherein, in response to anew computer device being added to the first plurality of computerdevices, at least one of the second plurality of computer devicesautomatically transmits at least one software plug-in to the newcomputer device.
 10. The healthcare communications system of claim 1,wherein the core nurse call functionality comprises functionalityregulated by a regulations entity and the additional functionalitycomprises non-regulated functionality.
 11. The healthcare communicationssystem of claim 1, wherein at least one of the first plurality ofcomputer devices and the second plurality of computer devicesincorporates Publish and Subscribe (PubSub) data communicationtechnology.
 12. The healthcare communication system of claim 1, whereinat least one of the first plurality of computer devices iscommunicatively coupled to a hospital bed and receive bed status datafrom the hospital bed.
 13. The healthcare communication system of claim1, wherein at least one computer device of the first plurality ofcomputer devices has auto-discovery software that is operable, inresponse to installation of the at least on computer in the nurse callsystem, to detect network connectivity and to initiate communicationswith a device manager.
 14. The healthcare communication system of claim13, wherein the device manager is operable to provide software modulesand/or network settings to the at least one computer device of the firstplurality of computer devices
 15. The healthcare communication system ofclaim 1, further comprising least one additional computer device that iscoupled to at least one of the computer devices of the first pluralityor second plurality of computer devices and that incorporates SessionInitiation Protocol (SIP) voice over Internet protocol (VoIP) technologyto separate the setting up and tearing down of voice calls between SIPenabled voice endpoint devices.
 16. The healthcare communication systemof claim 15, wherein the at least one additional computer devicecomprises a VoIP private branch exchange (PBX).
 17. The healthcarecommunication system of claim 1, wherein at least one of the firstcomputer devices comprises a VoIP room gateway that is operable todistribute communication data to multiple voice terminals or VoIP voiceendpoints installed in patient rooms and hallways.
 18. The healthcarecommunication system of claim 1, wherein the first plurality of computerdevices are interconnected in a tiered architecture arrangement toprovide fault isolation among the tiers so that faults occurring incomputer devices of one tier don't affect the operability of computerdevices in other tiers.
 19. The healthcare communication system of claim18, wherein at least one of the tiers comprises a subset of the firstplurality of computer devices that is associated with a patient room.20. The healthcare communication system of claim 18, wherein at leastone of the tiers comprises a subset of the first plurality of computerdevices that is associated with a nursing unit having a plurality ofpatient rooms.
 21. A healthcare communication system comprising: a firstplurality of computer devices operable as a nurse call system, the firstplurality of computer devices having core nurse call functionality, anda second plurality of computer devices operable communicatively coupledto the first plurality of computer devices, the first plurality ofcomputer devices being interconnected logically and/or physically in atiered architecture arrangement to provide fault isolation among thetiers so that faults occurring in computer devices of one tier don'taffect the operability of computer devices in other tiers and so thatfaults occurring in any of the second plurality of computer devicesdon't affect the core nurse call functionality of the first plurality ofcomputer devices.
 22. The healthcare communication system of claim 21,wherein at least one of the tiers comprises a subset of the firstplurality of computer devices that is associated with a patient room.23. The healthcare communication system of claim 21, wherein at leastone of the tiers comprises a subset of the first plurality of computerdevices that is associated with nursing unit having a plurality ofpatient rooms.